Important notice

doctorportal Learning is on the move as we will be launching a new website very shortly. If you would like to sign up to dp Learning now to register for CPD learning or to use our CPD tracker, please email support@doctorportal.com.au so we can assist you. If you are already signed up to doctorportal Learning, your login will work in the new site so you can continue to enrol for learning, complete an online module, or access your CPD tracker report.

To access and/or sign up for other resources such as Jobs Board, Bookshop or InSight+, please go to www.mja.com.au, or click the relevant menu item and you will be redirected.

All other doctorportal services, such as Find A Doctor, are no longer available.

What can and should we predict in mental health?

May 20, 2013

Med J Aust 2013; 198 (9): 459.

doi:10.5694/mja13.c0520

Authors: Astika Kappagoda, Ruth Armstrong

David Foster Wallace, in his novel Infinite jest (1996), described the impulse for a person at the point of suicide as like that of jumping from a burning high-rise building. “Their terror of falling from a great height is still just as great as it would be for you or me … [but] when the flames get close enough, falling to death becomes the slightly less terrible of two terrors.”

This is one way to conceptualise the situation for at least 2273 people in Australia who committed suicide in 2011. To understand how to prevent such deaths, we need to know — following Wallace’s metaphor — the point at which an individual will choose to jump rather than face the flames. Can we predict this? And to what extent can we predict any outcomes in psychiatry?

Much effort has gone into trying to identify patients who are at particular risk of completed suicide within a year after presenting in psychological crisis or after attempting suicide. Ryan and Large (doi: 10.5694/mja13.10437) argue that predicting the short-term risk of suicide for such patients is not possible given the lack of identified risk factors…